Cantekin Iskender

Inguinal herniorrhaphy in childhood may result in tubal damage and future infertility.

IntroductionInguinal hernias commonly occur during infancy. They are approximately six times more common in males than in females. They are one of the most common surgical conditions in childhood. About 5–20% of inguinal hernias have the ovary or fallopian tube in the hernia sac. Surgical interventions during childhood may cause damage. Unawareness of this damage can cause infertility in future.Case reportPresentation of a case diagnosed as having tubal damage during laparoscopic operation because of primary infertility with a history of inguinal hernia during her childhood. Inguinal hernia repair caused tubal damage and bilateral tubal occlusion as a cause of primary infertility.ConclusionMedical history is of great importance during infertility investigation and may reveal some unexpected conditions.

Neutrophil-to-lymphocyte ratio as a diagnostic marker of intrahepatic cholestasis of pregnancy

INTRODUCTION In this study, we aimed to investigate the relationship between neutrophil-to-lymphocyte ratio (NLR) and total bile acid (TBA) concentration in pregnant women with intrahepatic cholestasis of pregnancy (ICP). MATERIALS AND METHODS Fasting and postprandial TBA, NLR, and aminotransferase (AST/ALT) levels in the blood samples of 65 pregnant women with intrahepatic cholestasis were examined in this prospective case-control study. Thirty-three of the patients had mild disease and 32 had severe disease; 70 healthy women in uncomplicated pregnancies served as the control group. RESULTS Not only was the mean NLR elevated in the pregnant women with cholestasis when compared to the controls, but it also predicted the severity of the cholestasis. The correlation between fasting TBA and NLR was significant. COMMENTS Although TBA is still the diagnostic standard, NLR can be used as an initial screening tool due to its high specificity.

Behçet's disease and pregnancy: A retrospective analysis of course of disease and pregnancy outcome

Behçets disease (BD) is a rare, chronic, multisystemic disease of unknown cause. BD is characterized by mucocutaneous, ocular, vascular and central nervous system manifestations and is also associated with thrombogenicity. In this retrospective analysis we investigated the relation between gestation and BD.

Retrospective evaluation of pregnancy outcomes in women with familial Mediterranean fever.

Abstract Aim: Familial Mediterranean fever (FMF) is an autosomal recessive condition characterized by periodic attacks of fever, aseptic serositis and synovitis. In this study, we investigated maternal and neonatal outcomes in pregnant patients with FMF. Methods: This retrospective study consisted of 46 pregnant patients with FMF who attended the perinatology clinic of Dr Zekai Tahir Burak Research and Training Hospital between January 2008 and December 2012. The following clinical and demographic data were obtained by reviewing the patients’ medical records: maternal age, colchicine use during pregnancy, obstetric history, pregnancy outcome and maternal and neonatal complications during the current pregnancy. Results: The patients with FMF had higher rates of premature rupture of membranes (PROM) and Cesarean delivery as well as low birth weight infants; however, rates of stillbirth, gestational diabetes, preeclampsia did not differ between the groups. Preterm delivery rates were higher in the study group, but this difference did not reach statistical significance. Patients with pregnancy complications had significantly more basal proteinuria than did patients without complications. Nine patients did not receive colchicine therapy in the previous or current pregnancies. Within this subgroup, four (44.4%) of the patients had a history of two or more previous miscarriages. However, there were only three cases (8.1%) of two or more miscarriages among 37 patients who received colchicine; this difference was statistically significant Conclusions: FMF leads to higher rates of PROM, recurrent miscarriage and preterm deliveries. Colchicine treatment is safe in pregnancy and may lead to a decreased miscarriage rate.

Benign cystic lymphangioma presenting as a pelvic mass

We report a case of a 48‐year‐old woman with a complaint of chronic pelvic pain with a pelvic mass not related with uterus or adnexes. Preoperative ultrasonography or contrast enhanced computed tomography did not give accurate information on the origin of tumor. At laparotomy a cystic, retroperitoneal mass was totally resected without rupture. Final histopathological examination revealed that cystic spaces with abundant lymphocytes suggesting lymphangioma. No recurrence was detected in the follow up 6 months after total resection. As a result cystic lymphangioma should be considered as a rare cause of pelvic mass in women

Prediction of cardiovascular risk by electrocardiographic changes in women with intrahepatic cholestasis of pregnancy

Abstract Objective: We aimed to investigate P wave characteristics in pregnant women with and without intrahepatic cholestasis of pregnancy (ICP). Methods: In this case–control study, including 59 pregnant women with intrahepatic cholestasis and 28 with healthy uncomplicated pregnancies, electrocardiographic maximum (Pmax) and minimum (Pmin) P-wave durations and P-wave dispersion (Pd) parameters were investigated. Results: While Pmin and Pd values were significantly lower in women both with mild and severe ICP when compared to healthy pregnant women (p < 0.001), there was no significant difference between mild and severe disease groups. Conclusion: Intrahepatic cholestasis predisposes to cardiovascular complications. P-wave durations and Pd constitute a recent contribution to the field of noninvasive electrocardiology. Our data clearly demonstrated that these parameters were significantly altered in pregnant women with ICP when compared to the normal ones. This important association can be used to screen for women with an increased risk to better target counseling on lifestyle modifications and to closer follow-up and management of women with a history of ICP.

First-trimester crown-rump length affects birth size symmetrically

Abstract Objective: To investigate the relationship between crown-rump length (CRL) and birth weight, length and head circumference of the newborn. Methods: From a database of delivery records of 12 000 pregnancies, we identified 999 women with singleton pregnancies who had no medical problems, a normal menstrual history and a first trimester ultrasound scan in which CRL had been measured. All of the pregnancies resulted in live births without evidence of chromosomal and congenital abnormalities. The population in this study was divided into three groups according to CRL measurement; Group A (smaller-than-expected CRL), Group B (normal CRL) and Group C (larger-than-expected CRL). Results: The incidence of low birth weight infant was higher in Group A than in Group C (p = 0.010). The rate of small for gestational age (SGA) infants was similar between groups. The number of macrosomic or large for gestational age (LGA) infants was higher in Group C than Groups A and B. Both birth head circumference and length of infant were greater in Group C than Groups A and B. No significant difference for ponderal index value was observed between the groups (p = 0.927). Conclusion: The growth pattern in the first trimester affects neonatal birth weight and length symmetrically without changing the ponderal index.

Neonatal Injury at Cephalic Vaginal Delivery: A Retrospective Analysis of Extent of Association with Shoulder Dystocia

Purpose To describe the risk factors and labor characteristics of Clavicular fracture (CF) and brachial plexus injury (BPI); and compare antenatal and labor characteristics and prognosis of obstetrical BPI associated with shoulder dystocia with obstetrical BPI not associated with shoulder dystocia. Methods This retrospective study consisted of women who gave birth to an infant with a fractured clavicle or BPI between January 2009 and June 2013. Antenatal and neonatal data were compared between groups. The control group (1300) was composed of the four singleton vaginal deliveries that immediately followed each birth injury. A multivariable logistic regression model, with backward elimination, was constructed in order to find independent risk factors associated with BPI and CF. A subgroup analysis involved comparison of features of BPI cases with or without associated shoulder dystocia. Results During the study period, the total number of vaginal deliveries was 44092. The rates of CF, BPI and shoulder dystocia during the study period were 0,6%, 0,16% and 0,29%, respectively. In the logistic regression model, shoulder dystocia, GDM, multiparity, gestational age >42 weeks, protracted labor, short second stage of labor and fetal birth weight greater than 4250 grams increased the risk of CF independently. Shoulder dystocia and protracted labor were independently associated with BPI when controlled for other factors. Among neonates with BPI whose injury was not associated with shoulder dystocia, five (12.2%) sustained permanent injury, whereas one neonate (4.5%) with BPI following shoulder dystocia sustained permanent injury (p = 0.34). Conclusion BPI not associated with shoulder dystocia might have a higher rate of concomitant CF and permanent sequelae.

Fetal axillary cystic hygroma: A novel association with triple X syndrome

BACKGROUND Triple X syndrome is a relatively common sex chromosomal aneuploidy with an estimated incidence of one in every 1000 female births. There is considerable diversity in phenotypes among patients with triple X syndrome. Triple X syndrome has been shown to have associated abnormalities, with genitourinary malformations being the most consistent. Cystic hygroma (CH) is a lymphatic malformation that occurs because of the lack of development of communication between the lymphatic and the venous systems. CH has an incidence of 1 in every 6000-10,000 live births. CH is associated with a variety of conditions, including chromosomal aneuploidies and fetal malformations. CASE We report a case of prenatally detected triple X syndrome with axillary CH as an isolated finding. The patient was referred because of a fetal cystic mass at the right axillary region. Amniocentesis revealed 47,XXX karyotype, and no additional abnormalities were detected prenatally or after abortion. CONCLUSION This is a novel description of axillary CH associated with triple X syndrome.

Obstetrical complications associated with first‐trimester screening markers in twin pregnancies

The aim of this retrospective study was to investigate the relation between perinatal complications in twin pregnancies and the combination of first‐trimester maternal serum pregnancy‐associated plasma protein‐A (PAPP‐A) and free beta‐human chorionic gonadotrophin (β‐hCG) levels.